3 U.S. Health Workers Said to Be Infected

By LAWRENCE K. ALTMAN

Published: April 10, 2003

Three health care workers in the United States have caught a mysterious respiratory disease while caring for patients in this country, officials of the Centers for Disease Control and Prevention said yesterday. But they would not say where these cases occurred.

Dr. Julie L. Gerberding, the C.D.C. director, reported the third case in a talk at the University of California at Berkeley on Tuesday night, adding it to two earlier cases. The C.D.C. has also reported separate instances in which patients with the disease have transmitted it to six household members in this country.

The disease is known as SARS, for severe acute respiratory disease, and its cause is unknown. The United States cases in which SARS has been passed from one person to another, secondary transmission, have occurred since early March, with the most recent a few days ago, and all meet the case definition of suspect SARS cases, Dr. James M. Hughes, a top C.D.C. official, said.

As of yesterday, the C.D.C. has reported a cumulative total of 154 SARS cases to the World Health Organization, which is leading the investigation into the disease.

But in the daily reports of W.H.O., the United Nations agency in Geneva, it has not included the United States as a country where secondary transmission -- or what it calls local transmission -- has occurred, even though it has asked the C.D.C. about the specific cases daily for about a week, Dick Thompson, a spokesman for the W.H.O. said yesterday.

W.H.O. ''relies on countries to supply information about outbreaks in a precise and timely manner,'' Mr. Thompson said.

Dr. Hughes said the reason the C.D.C. had not reported that it had local or community transmission was that it uses a different definition. For the C.D.C., secondary transmission that occurs in a hospital or household setting where it might be expected does not constitute community transmission that has to be reported to W.H.O., Dr. Hughes said.

But, in the case of SARS, Dr. Hughes said, ''there is great confusion about what is community transmission versus what is transmission in recognized settings where transmission typically occurs.''

''This is an area of inconsistency that needs further discussion,'' Dr. Hughes said.

Because the secondary spread to hospital workers and household members ''represents close contact transmission of patient to health care worker or ill person to family contact in a household setting,'' the C.D.C. does not consider such secondary transmission as community transmission, Dr. Hughes said.

''What is important from a public health perspective is are you having uncontrolled transmission in a community setting, and that clearly is not happening in the United States,'' Dr. Hughes said.

Community transmission would require stricter control measures that are not necessary because it is not occurring in this country, Dr. Hughes said.

W.H.O. and C.D.C. officials have said that most transmission of SARS has occurred in hospital and household settings, although there is suspicion that the agent that causes SARS can be spread through contaminated objects.

W.H.O. has requested that each country affected by even a single case of SARS report all relevant information to its headquarters as part of the agency's emergency investigations of the disease. The hope is that quick action will prevent SARS from spreading further and from becoming one of the endemic diseases in many countries.

Many countries traditionally have been reluctant to comply with international agreements to report outbreaks and crucial cases of many diseases on a timely basis because such reporting can lead to severely hurt travel and economies.

W.H.O. and the C.D.C. have advised people with nonessential business not to travel to certain affected areas. In declaring SARS ''a worldwide health threat'' on March 15, W.H.O. officials said they knew the announcement would have severe economic consequences. Since then, SARS has deeply affected the economy in many Asian countries.

SARS is believed to have begun in Guangdong Province last November. But China has come under severe international criticism for not allowing teams of experts sponsored by W.H.O. to visit Guangdong and not reporting crucial details to W.H.O. until recent days.

''Part of the problem at the beginning of the SARS epidemic was that we did not understand what was going on in China,'' Mr. Thompson said.

In testifying before Congress on Monday, Dr. Gerberding, the C.D.C. director, said there were two second cases in health workers. She referred to the third case in her speech in Berkeley on Tuesday. ''We're confident it will turn out to be a true case,'' The Associated Press quoted Dr. Gerberding as saying.

Dr. Hughes said the first two health workers became ill in early March. One developed pneumonia and was hospitalized. The other was isolated at home. No further spread has occurred from those two workers, he said.

The third health worker case occurred in a different state. That worker became ill with suspected SARS in early April and has not been admitted to a hospital. All had close contact to a SARS patient before the disease was suspected and standard infection control measures for a respiratory disease were used, Dr. Hughes said.